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In Brief: Comparing the antidepressants

In Brief

Comparing the antidepressants

Published: March, 2006

A review suggests that the many antidepressant drugs introduced
since the mid-1980s are all about equally effective.

The survey covers 46 head-to-head comparisons between
antidepressants. Most of the drugs included are selective
serotonin reuptake inhibitors (SSRIs): citalopram (Celexa),
escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox),
paroxetine (Paxil), and sertraline (Zoloft). Also tested were
several drugs that have a different mechanism of action,
inhibiting the reuptake of norepinephrine alone or various
combinations of neurotransmitters: bupropion (Wellbutrin),
venlafaxine (Effexor), duloxetine (Cymbalta), and mirtazapine
(Remeron). About half of the trials compared two SSRIs, and the
rest compared an SSRI with one of the newer drugs. More than 90%
of the trials showed no more than a chance difference in
effectiveness between the two drugs. When several studies
directly compared two drugs, the investigators combined the
results for a meta-analysis. In these calculations, sertraline
and venlafaxine proved to be slightly more effective than
fluoxetine. Mirtazapine consistently, and venlafaxine in a few
studies, produced a slightly faster response than SSRIs.